LWPES: Treating Crohn's May Resolve Short Stature

by Ed Susman Contributing Writer, MedPage Today

Action Points

Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Explain that short stature observed in children with Crohn's disease can be resolved if the disease process is corrected – either through medical treatment, surgery, or using feeding aids.

Note that the role of growth hormone in the treatment of pediatric Crohn's disease remains controversial.

DENVER -– Short stature observed in children with Crohn's disease can be resolved if the disease process is corrected -- either by medical treatment, surgery, or using feeding aids, researchers said here.

At a session of the Lawson Wilkins Pediatric Endocrine Society meeting here, Bousvaros suggested that the medical literature points to the role of nutrition, infliximab (Remicade) and properly timed surgery as the best ways to control the disease process and help correct for growth failure.

"The role of growth hormone in the treatment of pediatric Crohn's disease remains controversial," Bousvaros said in his lecture. "Before using growth hormone in these patients, we should maximize conventional therapies first."

He said that to determine if growth hormone can be an effective treatment, clinical trials of growth hormone in the disease will require several hundred patients. The only three studies in the literature, he said, include a total of 37 children – and those results are mixed.

In one study, researchers conducted a randomized, placebo-controlled study that included seven children. Growth in the children treated with hormone was no different than in the placebo children (IBD 2006; 11: 435-441).

A second study enrolled 10 children in an open-label study and compared their growth with historical controls. The researchers found that after one year the children showed superior growth compared with the controls (J Pediatr 2008; 153: 651-658).

The third study randomized 20 children to standard therapy or standard therapy plus growth hormone. There was no placebo group. There was no change between groups in histological disease activity – the endpoint of the trial -- but there was mucosal healing observed with patients on growth hormone (J Pediatr Gastroenterol Nutr 2010; 51: 130-139).

"I would concur with Dr. Bousvaros that growth hormone should be withheld until other treatments have been tried," said Surendra Varma, MD, vice chair of pediatrics at Texas Tech University Health Science Center in Lubbock.

In addition to being very expensive, Varma told MedPage Today, treatment with growth hormone can be inconvenient because it requires twice-a-day dosing, and outcomes are not clear-cut.

"If you attack the disease process you can get very good results in children," said Varma.

In his talk, Bousvaros said that in treating growth failure in inflammatory bowel disease, doctors should adhere to three principles of therapy: control inflammation, minimize corticosteroid use, and optimize nutrition.

To accomplish those goals, he suggested clinicians aim for clinical remission of Crohn's disease, not just relief of symptoms. He said immunosuppressants and biologic agents would be preferred over corticosteroids, and properly timed surgery to remove the cause of inflammation – often a small section of the bowel – can also be effective.

He said that treatment with infliximab has shown to help a majority of responders to achieve disease remission.

Bousvaros said that use of feeding tubes can be effective in improving nutrition, although most children don't like the tubes. Intermittent use of feeding tubes, he said, can also be effective. He illustrated that with correction of nutrition and reduction of inflammation, growth curves accelerate.

Little, however, can be done when the child is short because he has short parents. Genetics is the determinant in these cases, he said.

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